Clostridial sepsis following hepatic arterial infusion chemotherapy

Three patients with clostridial sepsis during or following hepatic arterial infusions for the regional chemotherapy of hepatic metastatic tumors are described. In all patients abdominal roentgenograms revealed lucencies in the right upper quadrant consistent with gas-containing hepatic abscesses at the time of clinically apparent sepsis and positive blood cultures. The occurrence of three such cases in one year and the low incidence of clostridial infections in non-catheterized oncology patients at our institution suggest that clostridial infection is a previously unrecognized complication of hepatic arterial infusion chemotherapy. The possible sources of the infecting organisms and pathogenesis of this infection are discussed.